Dynamic Disruption LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

DYNAMIC DISRUPTION LLC

Practice address

18200 Ravenswood Rd
Altoona, FL 32702-9724

Phone

(302) 364-5459

NPI assigned

Feb 21, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Christopher Robert Cline, JD LLM

Title

Owner / Managing Member

Phone

(302) 364-5459

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519171200000",
    "number": "1619477130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18200 RAVENSWOOD RD",
            "city": "ALTOONA",
            "state": "FL",
            "postal_code": "327029724",
            "telephone_number": "407-446-9911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18200 RAVENSWOOD RD",
            "city": "ALTOONA",
            "state": "FL",
            "postal_code": "327029724",
            "telephone_number": "302-364-5459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC DISRUPTION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-21",
        "last_updated": "2018-02-21",
        "status": "A",
        "authorized_official_last_name": "CLINE",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER / MANAGING MEMBER",
        "authorized_official_telephone_number": "302-364-5459",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "JD LLM"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Altoona, FL
• Providers in Altoona, FL by specialty
• Prosthetic/Orthotic Supplier in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.